Vaginal Prolapse

What is bladder prolapse?

Under normal conditions in women, the bladder is held in position by a “hammock” of supportive pelvic floor muscles and ligaments. When these muscles and tissues are stretched and/or weakened, the back of the bladder can sag through this layer of muscles and ligaments and into the vagina, resulting in bladder prolapse, also referred to as a cystocele. In severe cases, the sagging bladder will appear at the vagina’s opening and can even protrude (drop) through it. Bladder prolapse can be very bothersome, can be associated with problems emptying the bladder, urinary tract infections or incontinence (unwanted loss of urine), and can usually be corrected.

What causes bladder prolapse?

Prolapse can develop for a variety of reasons, but the most significant factor is stress on this supportive “hammock” during childbirth. Women who have multiple pregnancies or deliver vaginally are at higher risk. Other factors that can lead to prolapse include: heavy lifting, chronic coughing (or other lung problems), constipation, frequently straining to pass stool, obesity, menopause (when estrogen levels start to drop) and previous pelvic surgery.

What are the symptoms for bladder prolapse?

Symptoms associated with prolapse include: frequent urination or urge to urinate; stress incontinence; not feeling bladder relief immediately after urinating; frequent urinary tract infections; discomfort or pain in the vagina, pelvis, lower abdomen, groin or lower back; heaviness or pressure in the vaginal area; painful intercourse; or tissue protruding from the vagina that may be tender and/or bleeding. Mild cases of prolapse may not cause any symptoms.

How is bladder prolapse detected?

Prolapse can usually be detected with a pelvic examination. However, a voiding cystourethrogram may be required. This test involves a series of X-ray pictures that are taken during urination which will show the shape of the bladder and will help identify obstructions blocking the normal flow of urine. Other X-rays and tests may also be required to find or rule out problems in other parts of the urinary system, including urodynamics, cystoscopy and fluoroscopy.

What are the treatment options for bladder prolapse?

For mild prolapse cases, behavior therapies such as Kegel exercises (which help strengthen pelvic floor muscles) may be enough. Other treatments for more advanced cases can include estrogen replacement therapy, and a pessary (vaginal support device) to provide better support for the organs. Surgery is usually required for bothersome cases that cannot be managed with a pessary.
If prolapse is left untreated, over time the condition may get worse. In rare cases, severe prolapse can cause urinary retention (inability to urinate) which may lead to kidney damage or infection.